A CASE PRESENTATION ON ACUTE DECOMPENSATE HEART FAILURE.pptx

It contains a detailed description of the disease and case study

1. A CASE PRESENTATION ON ACUTE DECOMPENSATE HEART FAILURE

2. INTRODUCTION Acute Decompensated Heart Failure (ADHF) is a sudden worsening of functioning of heart which can be life-threatening if not treated promptly and effectively.

3. EPIDEMIOLOGY: He art failure is a significant public health concern globally, with approximately 26 million people affected worldwide. In India, the estimated prevalence of heart failure is around 4.5 million cases, with a significant annual incidence of 491,600 new cases. The mortality rate due to heart failure in India is also substantial, accounting for approximately 235,000 deaths each year. The prevalence of heart failure increases with age, ranging from 3.4% in those aged 60-69 years to 12.4% in those aged 80 years and above. Regional variations also exist, with higher prevalence rates observed in urban areas (5.5%) compared to rural areas (3.4%), and in North India (5.8%) compared to South India (4.3%).

4. ETIOLOGY: 1. Coronary artery disease 2. Hypertension 3. Cardiomyopathy 4. Heart valve disorders: Stenosis, regurgitation. 5. Cardiac arrhythmias: Atrial fibrillation, ventricular tachycardia. Non-Cardiac Causes: 1. Chronic kidney disease 2. Chronic obstructive pulmonary disease 3. Obesity

5. PATHOPHYSIOLOGY: 1. Ventricular remodeling: Chamber dilation, hypertrophy, or fibrosis. 2. Neurohormonal activation: Release of catecholamines, renin-angiotensin-aldosterone system (RAAS), and vasopressin. 3. Inflammation: Activation of inflammatory pathways, cytokine release, and oxidative stress. 4. Endothelial dysfunction: Impaired vasodilation, increased vascular resistance Compensatory Mechanisms: 1. Sympathetic nervous system activation: Increased heart rate, contractility, and vasoconstriction. 2. RAAS activation: Increased aldosterone, sodium retention, and fluid overload. 3. 3. Vasopressin release: Increased water reabsorption, fluid overload, and vasoconstriction.

6. CLINICAL MANIFESTATIONS 1. Shortness of breath 2. Fatigue 3. Swelling (edema): Fluid buildup in legs, ankles, feet, or abdomen 4. Cough 5. Chest pain: Pressure, tightness, or discomfort in the chest. 6 Palpitations 7 Dizziness or lightheadedness 8 Nausea and vomiting 9 Decreased urine output

7. DIAGNOSIS Laboratory Tests: 1. Complete Blood Count 2. Serum electrolytes 3. Kidney function tests 4. Liver function tests 5. Thyroid function tests Imaging Tests: 1. Chest X-ray 2. Echocardiogram 3. Cardiac MRI Other Tests: 1. Electrocardiogram 4. Cardiac biopsy

8. TREATMENT:- 1. In severe/acute cases, Inj. Frusemide 40-80 mg IV stat and repeated after 2-3 hours. Individualize the maximum dose up to 200 mg/day. Maintenance dose is 40 mg IV 12 hourly till clinical improvement is seen. High dose of Frusemide infusion, i.e. 10 mg/h undiluted and 1 mg/h as continuous infusion can be used in refractory patient. 2. Tab. Spironolactone 25-200 mg daily may be used in combination with above. Or Tab. Chlorothiazide 250-500 mg/day. Or Tab. Benzthiazide 25 mg + Tab. Triamterene 50 mg/day. 3. Tab. Enalapril 2.5-20 mg/day may be given as a single or two divided doses.

9. 4. Tab. Isosorbide mononitrate 60 mg/day preferably as slow release preparation given at night. 5. Digoxin is indicated in fast ventricular rate (e.g. in atrial fi brillation). Inj. Digoxin 1 mg IV, followed by 0.5 mg at 8 and 0.25 mg at 16 hours Or 0.5 mg followed by 0.25 mg PO at 8, 16 and 24 hours (rapid digitalization) followed by 0.125-0.375 mg/day as maintenance dose. 6.Tab. Carvedilol 3.125 - 25 mg per day in single/or two divided doses (useful if persistent tachycardia, idiopathic dilated cardiomyopathy) — dose to be doubled,

10. DEMOGRAPHIC DATA: Patient name :- XXX Age/Gender :- 70Y/ male Admission No :- 20183 Department/Ward :- Male Medical Ward Date Of Admission :-23-10-24 Consultant Doctor:- Dr Sreenivasulu MD SOAP NOTES SUBJECTIVE EVIDENCE : A 70yrs old male patient was admitted in the Male medical ward under the consultant doctor Dr.Sreenivasulu M.D with the chief complaints of SOB since 20 days, pedal edema since 1 week( pitting type), fever since one week high grade ass with chills The Past Medical History of the patient include that the patient is a k/c/o HTN on unkowmedication k/c/o HF not on medication, takes symptomatic treatment for SOB ocassionally since 3 yrsThe Personal history & habits of patient includes mixed diet, sleep & appetite was normal, bowel &bladder habit was regular , not an alcoholic & smoker.The Family History shows nothing significant data.

11. OBJECTIVE EVIDENCE RFT RESULT NORMAL VALUE SR CREATININE 1.1 0.4- 1.4 mg/ dl SR BUN 40 0- 50 mg/ dl CBP RESULT NORMAL VALUE Hb 11.6 12-15 g/dl Wbc 6000 4000-11000cells/cumm RBC 4.0 3.5-5.5millions/cumm Platelet 3.0 1.5-4 L/cumm

12. SERUM ELECTROLYTES Results Normal values Serum sodium 140mmol/lit 135-155mmol/lit Serum potassium 3.8mmol/lit 3.5-5.5mmol/lit Serum chlorides 98mmol/lit 90-110mmol/lit LIVER FUNCTION TEST RESULTS NORMAL VALUE SR creatinine 4.0mg/dl 0.6 – 1.2mg/dl T.bilirubin 0.6mg/dl Upto 1gm/dl SGPT 184 U/L Upto 35 IU/L SGOT 64 IU/L Upto 40 IU/L ALP 63 IU/L Upto 120 IU/L Total protein 5.8 gm/dl 4.0- 8.0 gm/ dl Sr Albumin 3.7 gm/ dl 3.2- 5.0 gm/ dl

13. 2D ECHO: IMP: Dilated all chambers Global hypokinase of LV Severe LV systolic dysfunction EF:- 28% CHEST XRAY: pleural effusion FUNDUS EXAMINATION:- Both eyes grade 1 HTN retinopathy noted

14. ASSESSMENT: Based on subjective and objective evidence the patient is known case of HYPERTENSION AND HEART' FAILURE

15. BRAND NAME GENERIC NAME INDICATION DOSE ROA FREQUENCY DAYS Inj lasix Furosemide Loop diuretic 40mg IV BD 23/10- 26/10/24 Tab ARNI Sacubitril+ Valsartan To treat heart failure 49mg 51mg PO BD 23/10-26/10/24 Tab Telma Telmisarton Anti HTN 40mg PO OD 23/10-26/10/24 T Dapagliflozen Dapagliflozen To treat heart failure 10mg PO BD 23/10-26/10/24 T Aldactone Spiranolactone Potassium sparing diuretic 50mg PO OD 26/10-till date Syp looz Lactulose Laxative 10ml PO OD 25/10- 26/10/24 P L A N I N G

16. T Hydrocortisone Hydrocortisone Corticosteroid 100mg PO OD 26/10- till date T sporlac Lactic bacillus Probiotics 10000units PO TID 26/10-till date T B complex Vitamin b12 Vitamin supplement 200mg PO OD 26/10-till date

17. Prognosis chart: PROGNOSIS TREATMENT Day 1 PR : 73bpm RS: BAE+ BP ; 130/90mmhg SPo2 : 91% with RA RX INJ LASIX 40MG IV BD T ARNI (49/51) PO. BD T TELMISARTON 40 MG PO BD T DAPAGLIFLOZEN 10MG PO BD T ALDACTONE 50MG PO OD Day 2 PR : 81bpm RR : 22 cpm BP : 110/70 mmhg Spo2 :98% with RA CNS: NFND CVS: S1S2+ GRBS :- 120mg/ dl CST

18. Day 4 C/o constipation since 4 days PR : 91bpm RR : 22 ccpm BP : 120/90 mmHg Spo2 :98% with RA CVS : S1S2+ PA: soft CST Add SYP LOOZ 10ML PO OD Day 5 c/o loose stools 6 episodes & SOB PR : 101bpm RR : 22cpm Spo2 : 96% with RA BP: 110/90 mmHg RS: BAE+ PV: NORMAL CVS: S1S2+ CST STOP. SYP LOOZ & INJ LASIX ADD T FUROSEMIDE 20MG PO BD T SPORLAC TID T B COMPLEX PO OD

19. DRUG MECHANISM OF ACTION ADRS MP Inj lasix ( Furosemide) It inhibits the absorption of sodium and chlorides in proximal , Loop of henle and distal tubules Hypotension Hypokalemia Serum electrolytes Tab sacubitril & valsartan It inhibits the enzyme neprilsyn, this inhibits natriuretic peptides which are blood pressure lowering substance Valsatan is angiotensin II receptor blockers selectively blocks AT1 receptor leads to vasodilation, reduce aldosterone secretion Hypotension Hyperkalemia Dizziness Cough Headache Monitor cardiac function & BP DRUG PROFILE: Tab Telmisarton Telmisarton is angiotensin II receptor blockers selectively blocks AT1 receptor leads to vasodilation, reduce aldosterone secretion Cough Headache Monitor BP

20. DRUG MOA ADRS MP Tab Dapagliflozen It inhibits SGLT2 , leading to increase urinary glucose and sodium excretion reduce intravasular volume and improve cardiac function Hypoglycemia Nausea Vomiting Monitor blood glucose level T Aldactone ( Spiranolactone) It inhibits the effect of aldosterone by competing for aldosterone dependent sodium potassium exchange site in distal tubules Electrolytes imbalance Serum electrolytes Syp lactulose It is laxative makes stools easier to pass by drawing water into your bowel Diarrhea Nausea Abdominal pain Monitor GI Symptoms

21. DRUG MOA ADRS MP Tab B COMPLEX Serves as neutrasmitter synthesis And works as anti oxident sour taste Insomnia Monitor CBP Tab sporlac It helps in restoring the good bacteria in intestine, this prevents diarrhea and loss of beneficial bacteria Bloating Belchings Monitor GI Symptoms T Hydrocortisone An adrenocortical steroids that inhibits accumulation of inflammatory cells Increase BP Weight gain Monitor BP , Blood glucose level

22. RATIONALITY: The therapy given was found to be irrtional as no treatment given for jaundice POSSIBLE DRUG DRUG INTERACTIONS: DAPAGLIFLOZEN+ FUROSEMIDE: Increase risk of hyperglycemia FUROSEMIDE+ SACUBITRIL & VALSARTAN: Risk of renal failure and hypotension FUROSEMIDE+ TELMISARTON:- Risk of hypotension FUROSEMIDE+ HYDROCORTISONE: Risk of hypokalemia REGARDING DISEASE: It is condition where sudden worsening of heart failure is seen PHARMACIST INTERVENTION:

23. REGARDING DRUGS: Tab ARNI taken orally two times a day Tab Telmisarton 40mg taken orally once a day Tab spiranolactone 50mg taken orally once a day Syp lactulose 10ml taken orally once a day at night Tab Hydrocortisone 100mg taken orally once a day at night Tab sporlac taken orally three times a day T B COMPLEX 200mg taken orally once a day

24. LIFE STYLE MODIFICATIONS 1. Reduce sodium intake 2. Increase potassium-rich foods 3. eat omega 3 rich foods 4. Limit fluid intake Stress Management: 1. Meditation and mindfulness 2. Yoga 3. Deep breathing exercises Sleep: 1. Get adequate sleep 2. Establish a sleep schedul Monitoring: 1.Weight loss 2 Regular follow-ups with your healthcare provider

25. REFERENCE : 1.Micromedex solutions.com 2.Standard treatment guidelines from sangeeta sharrma

26. THANK YOU